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X. APPLICATION FOR SANITATION PERMIT Permit No. S 7 ..... (Complete in Duplicate) Date Issued f l:..:............. Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND LOCATI -------- �J`- �C --------------------•------- �/�� Owner's Name '`=M ` --------------- Phon� 7` e _ (/ Address---------------------------------------- ?274V--C� r . !zt Contractor's Name-------..................... - ---------------------------------------------------------------------------•--- Phone.l Installation will serve: Residence 2---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. _ Number of bedrooms ..'Y Number of baths __/... Lot size ------r __-------------- __ !. .___----___ Water Supply: Public system 9�/<ommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay L ❑ Clay Ado ardpan ❑ 4 Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Ta Distance from nearest well-----------------Distance from foundation--------------------Material----____---_-__----___-__-___----_--_-----__-__-. \ �-�7 No. of compartments----------- --------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- osal Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. (L '&� Number of lines-----------------------------------Length e------------------------------Width of trench---------------------------------- �' . Type of filter material------------------------- th of filter, a ria---------------------- length-_.___-_-______________-___.-_---_------__ Seepage Pit: Distance to neares/� well 'fr�!------Distanc f� u tion_. _�.._..Distan �t nearest lot lir ----- Number of pits----f -____-Li ng materia tL7.._.__ d ze: Di meter-_. --.-___Depth-c;_a[------------------------ Cesspool: _�_________________ Cesspool: Distance from nearest well---------------_Distance from foundatio ------.-------------Lining material--.---._-__-________-______--.__--_-_. ❑ Size: Diameter--------------------------------- ---Depth----------•-------- ---------------------------Liquid Capacity........--------------------gals' Privy: Distance from nearest well---------------------------_---------------------Distance from nearest building------------------------------------------ 171 Distance to nearest lot line----------------------------------------------------------------------- -----------••---------------------•----------------------------------- Remodeling and/or repairing (describe):---------------------------••------------•••----•----------•------------•-----•----•-•-----•---------------------•--------••--•--------•-------•-------- --------•----------------------------------------------------•------------------------------------------------•----------•---------------------------------------------------------------------------•------------------------ ---------••-----------------------------------------•-•-•--•------•----•••-----••-------•-----•--•------------•---------------•---•---•----••--------•-----------•------•--•----------•----••------------•••----------------- - ------ ------ ------ ----- ------- ---- ------------ ----------------•--- ------ ------ •-------------- - ---- I hereby certi that I have repared t s pli tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rules nd re la io s o the S Joaquin Local ealth District. (Signed) -- ----- ---- Contractor) ----------------------------- -- By:.---•--------••------...---•----•••-•-------•-•---•---••--•------------------- ------------(Title t - gib'------ ' (Plot plan, showing size of lot, location of system in re ion to wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -` --------------------------------------------------------- DATE �� `� REVIEWEDBY------------------------------------------ ------------------------------------------------------------------•---•-------- DATE........................................................... BUILDINGPERMIT ISSUED................................--------------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations-----------------------------------------------------------------------------------------------------------------------------------•----•----•---...--••------- -------------------------------•------------------------------------- --------------------------------------------------------------------------------------------------------............................................... •-•--•------•-------------•----•--•••••---•-•---------••--•-----------•---------------------------------------------------•---------------•-----...-----•------••-•-------•--•--------•---•-••--•••--•--------------••-----•-- ------•---------•----------•-------------- ------•---...•-•------------------•--•-------------------------------------------............------------------------------•-----.....----------------------------•-•--....•----- ------------------------------------------------------- ----- ----- ----------------------- ----- ------ -- ------ FINAL INSPECTION BY:----- -'� ----------------- ------ Date---1.._. - --� -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100